IPACHTE# Zi. arnett County Department of Public Health
Improvement Permit 27039
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION / ( 611 0
ISSUED TO• t/ /Z d ' SUBDIVISION LOT # .
NEW 5 R PAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 5rrb
Proposed Wastewater System Type: �% t U a— 3
Projected Daily Flow: GPD
Number of bedrooms: of Occupants: max
Basement ❑Yes 0 No
Pump Required: ❑Yes ❑ No IJr M be required based on final location and elevations of facilities
Type of Water Supply: El Community Public ❑ Well Distance from well feet Permit valid for: Z Five years
Permit conditions: ❑ No expiration
5—,W fidtlr X52—
Authorized State Age Date: SEE ATTACHED SITE SKETCH
The issuance of this permit b t Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Construction Authorization
(Required for Building_ Permit)
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1957, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be installed in accordance
with the attached system layout.
ISSUED TO: C. -/t G 6 r PROPERTY LOCATION: - V'(- - %YZCI 6 Z%r
SUBDIVISION LOT #
Facility Type: i New �❑� Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes No
Type of Wastewater System* Z5 °la 2 i r,� Qp --- (Initial) Wastewater Flow: 3 60C GPD
(See note below, if applicable ❑)
w t-. ale , 5 (Repair)
Installation Requirements /Conditions Number of trenches 3
Septic Tank Size gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Exact length of each trench itb feet
Trenches shall be installed on contour at a
Maximum Trench Depth of. 11 "'" "Y' inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover: inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
Conditions: '5—, a y a- 1� >y r ?,,&b &12
WATER LINES (INCLUDING IRRIGATION) MUST BE LOFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
inches below pipe
'2 inches above pipe
')2- inches total
* *If applicable: / understand the system type specified is different from the type specified on the application. / accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subject to revocation if the site plan, plat or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
n I — rur—n
Construction Authorization is subject to compliance with the provisions of the Laws and Rules for sewage Treatment and Disposal and to the conditions of this permit 3tt HI iALntu 3iit JfitiLn
Authorized State Ag ! Date: # — t Z
Construction Authorization Expiration Date: I --
HTE # 12 — -5— — '2-S to 4i3 Permit # 70
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Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL /SITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
Owner: Applicant:C./
Address: Date Evaluated:
Proposed Facility: 5 Design Flow (.1949): 3
Location of Site5tjE & -- Property Recorded:
Water Supply: . ❑- Public❑ Individual ❑ Well
Evaluation Method: ❑,'AugerBoring ❑ Pit ❑ Cut
Type of Wastewater: ❑.-Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring
❑ Mixed
❑ Other
P
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1
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#
.1940
Landscape
Position/
Slope%
Horizon
Depth
(In.)
SOIL MORPHOLOGY
.1941
OTHER
PROFILE FACTORS
Profile
Class
& LTAR
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
.1943
Soil
Depth IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
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dry " t%iJ
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dirt
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Description
Initial
System
Repair System
Other Factors (.1946):
Site Classification (.1948):
Evaluated By: f y
Others Present: �--
Available Space (.1945)
System Type(s)
2- j
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SiteLTAR
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